Diabetes Mellitus Type 2: New Advances & Research

Leon LateganUniversity of Johannesburg

South Africa

At a Glance

Diabetes

Complications

Current Research

Summary and Take Home Message

Diabetes Mellitus (DM)

“Sugar Diabetes”

Increased blood glucose concentration

Type 1: no insulin produced by the pancreas (10%)

Previously “juvenile diabetes”

Type 2: insulin resistance at cellular level (90%)

Previously “adult-onset diabetes”

Prevalence

App. 347 million people worldwide have diabetes.

More than 80% of people with diabetes live in low- and middle-income countries.

The WHO projects that diabetes deaths will double between 2005 and 2030.

Africa: 12 million in 2010 projection is 24 million in 2030

(WHO)

DM in Africa

Sub-Saharan Africa

• Mauritius: 15%

• Botswana: 11%

• Zimbabwe: 10%

• South Africa: 7%

• Zambia: 5%

• Mozambique: 3%

• Egypt: 16.5%

• Iran: 10.5%

• Gabon: 10%

• Algeria: 7.5%

• Cameroon: 6%

• Kenya: 5%

• Nigeria: 5%

• Ghana: 3%

Warning Signs of DM

Polydipsia: increased thirst

Polyuria: increased urination

Polyphagia: excessive hunger

Fatigue

Many infections

Headaches

Blurred vision

Dizziness

Dehydration

Rapid heart rate

Unexplained weight loss

Diagnosis of DM

Fasting glucose test: ≥ 126 mg·dL−1 (7.0 mmol·L−1)

Glucose tolerance test: ≥ 200 mg·dL−1 (11.1 mmol·L−1)

HbA1c : ≥ 6.5%

or

Diabetic emergency: vomiting, dehydration & ketoacidosis, …

Complications of DM Hypo- and hyperglycemia: coma & death

Retinopathy: loss of vision / blindness

Peripheral neuropathy & gangrene: limb amputation

Renal / kidney failure: death

Coronary artery disease: myocardial infarction or stroke

Thus, DM has to be managed !

Current Research

Pearls from 2010 – 2014

Warning:

Not a systematic review or Meta-analysis

Change in Physical Activity after a Diabetes Diagnosis: Opportunity for

Intervention

A disease diagnosis may motivate Pxs to increase their physical activity levels.

Primary healthcare practitioners should thus make use of this opportunity/window to educate their Pxs about the role of physical activity.

Schneider et al. (2014). Med Sci Sp & Ex, 46(1):84-91

Investigating telephone support as a strategy to increase the physical activity levels of

people with diabetes

12 Telephone calls: once a week for 20 minutes each

“The number of people classified as active increased by 31% and 85% were considered physically active at the end of the intervention.”

The results verify the efficacy of telephone support as a strategy to increase physical activity levels in people with diabetes …

Zanetti et al. (2014). Journal of Diabetes Nursing, 18(1):p32-36

Suggestion

Why not Consider DM Education & Motivation to Exercise:

Bulk SMS

E-mail

WhatsApp

Twitter

FaceBook

Etc…

Beyond Basic Exercise Guidelines: Is Sitting really the new Smoking?

Sedentary time is closely related to adverse health risks even if individuals perform physical activity on a daily basis.

…too much sitting can be detrimental to health …

Mary Stenson (College of Saint Benedict, Saint John’s University) Forum Lectures: 2-6-2014

So what happens when we sit ?

Associations of overall sitting time and TV viewing time with fibrinogen and C reactive protein: the

AusDiab study

Conclusions: Overall sitting time was positively associated with plasma fibrinogen and high sensitivity CRP in men and women.

Plasma fibrinogen & CRP are important markers of all-cause mortality and cardio-metabolic disease like DM T2.

Howard et al. (2014). Br J Sports Med, 1-5

Conclusion

Sitting may make you

sick

PHARMACOLOGICAL EXERCISE MIMETICS IN THERAPY: DELUSION OR FUTURE?

Recognizing the beneficial effects of physical activity on health researchers have focused on the active substances that mimic or potentiate the effects of

exercise and big pharmaceutical companies see a potentially huge market and profit in this

However, mimicking exercise by means of drugs can lead to a chronic catabolic state.

Vitošević et al. (2013). Acta Medica Medianae, 52(4):58-62

High-intensity exercise training for the prevention of type 2 diabetes mellitus

The American Diabetes Association (ADA) recommends that adults with prediabetes engage in ≥ 150 minutes per week of moderate activity and target a 7% weight loss.

Although patients can accrue all exercise benefits by performing low intensity or medium intensity activities such as walking, high intensity activities (>70% HRR or 14-16 RPE) represent a time-efficient alternative to meeting physical activity guidelines.

Rynders & Weltman (2014). The Physician and Sportsmedicine, 42(1):7-14

One Bout of Exercise Alters Free-Living Postprandial Glycemia in Type 2

Diabetes

One bout of 60 minutes of aerobic exercise at a moderate intensity (70% HRmax) reduced average blood glucose levels for 24 hours

The authors concluded that Type 2 diabetics should exercise daily to reap the maximal benefits from exercise.

Oberlin et al. (2014). Med Sci Sp & Ex, 46(2):232-238

Exercise prescription for patients with type 2 diabetes and pre-diabetes: A position statement from Exercise

and Sport Science Australia

210 min/week

Moderate intensity: 60% - 70% HRmax

Combine aerobic & resistance exercise

Hordern et al. (2012). Journal of Science and Medicine in Sport, 15: 25–31

Conclusion

Why look for a new drug when we have:

EXERCISE

Exercise is Medicinefor Diabetes

Example of an Exercise Programme for a Diabetic

Walk / jog / cycle for 30 min

Push-ups & Lunges 2 sets of 15 reps

Stretch Hamstrings, Calves and

Lower back 2 x 30 sec

Summary

Africa is not immune to DM

DM has serious complications

Sitting time must be reduced

Education & Communication is important

Exercise must form part of DM management

Questions

Diabetes:Risks during exercise

Hypoglycemia (<4.0 mmol/l) – very rare in DM T2, but should be avoided in Type 1 Pxs

Abstain from exercise during acute illness or with fever

Peripheral Neuropathy – monitor feet for blisters and wounds that don’t heal

Comorbidities: Hypertension, Peripheral vascular disease, Obesity & OA

Children Active To Stay Healthy (CASH): Exercise as a Tool for

Reducing Inflammation and Cardiovascular Risk in Sedentary,

Pubescent Adolescents With Obesity

… high intensity interval exercise … may elicit greater improvements to endothelial function … for children with obesity, but also other inflammatory diseases such as diabetes, cancer, and arthritis.

Starkoff, Brooke E. (Doctoral Dissertation)

The Ohio State University, 2013

Cognitive status and foot self care practice in overweight diabetics,

engaged in different levels of physical activity

Regular physical activity can help promote cognitive status and foot self care practice in overweight patients with type 2 diabetes.

Journal of Diabetes & Metabolic Disorders

February 2014, 13:31

Exercise Dose ?

Heart Rate Physical Activity Score (HRPAS)

HRPAS = % HRR x duration (min)

Example:

HRPAS = 60% HRR x 20 min

= 120

Miller et al. (2014). Med Sci Sp & Ex, 46(1):69-75